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Can new methods help doctors find high-risk patients?

Road
One step along the road is for doctors to become better at finding patients with elevated blood lipids who are most at risk of falling ill with cardiovascular disease.

Heart attacks and strokes are the most common causes of death in the world. One of the biggest risk factors for these diseases consists of elevated levels of blood lipids. Researchers are currently working on developing and testing new methods to help doctors find patients at high risk of these diseases. If proven successful, they could also help patients with diabetes.

Many people are unaware of the fact they have elevated levels of blood lipids before they experience complications, such as a heart attack or stroke. It is also common to discover elevated blood lipid levels when diabetes is diagnosed. Today, there are good treatments and most people, with the help of medication and a healthy lifestyle, can keep blood lipid levels under control and avoid further complications.

“In recent decades, we researchers have been good at identifying a number of very important risk factors for cardiovascular disease, including lipid disorders, that is, high levels of cholesterol and other fats in the blood. Treatment of such risk factors has led to a reduction of death from sudden cardiac arrest – however, the number of deaths is still too high and we must do more”, says Viktor Hamrefors, doctor and researcher in cardiovascular diseases at Skåne University Hospital (SUS) and Lund University.

Finding patients most at risk of relapse

One step along the road is for doctors to become better at finding patients with elevated blood lipids who are most at risk of falling ill with cardiovascular disease.  

“As a doctor, I want to know which patients are most at risk of facing complications and therefore require extra intervention, for example with stronger medication”, says Viktor Hamrefors.

Viktor Hamrefors works as a doctor at the lipid clinic at SUS where several hundred patients with different kinds of lipid disorders, both hereditary and other types, are referred each year. From autumn 2018, these patients may be included in a study where the current established methods to assess the risks for complications are compared with a combination of established and completely new risk analysis methods.

“The aim of our study is to see if we can make risk assessment more accurate for these patients. The question is whether the categorisation of patients in different risk groups can be made more nuanced, more precise, if the newest method is used at the clinic?”

New methods of analysis tested at the lipid clinic

If you have problems with elevated blood lipids and have been referred to the lipid clinic, you may be offered the opportunity to participate in Viktor Hamrefors’ study. As part of the study, your risk of further complications will be assessed based on the current best practice or on a combination of established and completely new risk analysis methods.

If you end up in the group being studied with the help of the current best practice the doctors will base their risk assessment on the results from analyses that identify and measure the levels of different kinds of blood lipids, both good and bad. An analysis of whether you have any of the most common forms of inherited elevated blood lipids is also performed. If you end up in the other group that is also going to be assessed based on new methods, you will also have a CT scan and ultrasound to see how much narrowing of the arteries there is in your coronary and neck vessels. An extended blood analysis is also conducted, in part to search for metabolites – small molecules that reveal what your cholesterol consists of in much more detail – and in part to see if, aside from any of the normal hereditary forms of elevated blood lipids, you have any other genetic variants that increase the risk of lipid disorders.

For doctors, the study means they can also learn to interpret and conduct a risk assessment based on many different kinds of results. Irrespective of which patient group you belong to in the study, your doctor will compare your overall risk score with an existing risk scale, and based on where you are on the risk scale the doctor will make an assessment of the kind of treatment you need.

“Then we will monitor all patients to see if those with risk assessments based on a combination of established and new methods receive a better prognosis, if the outcome is better for them than for patients assessed only based on the established methods. With current methods it is possible that a patient is assessed as medium-high risk – however, if the new methods are introduced maybe we would discover that the patient is actually at high risk and requires stronger treatment.”

Increased precision could also help diabetes patients

Providing doctors with tools to better assess which patients are at significant risk of complications is one way for the health care system to give more precise – individualised – treatments. Paul Franks from the Lund University Diabetes Centre explains why more precise treatments are needed:

“Different patient groups can be sensitive in different ways and be at different degrees of risk of developing, for example, diabetes. If doctors were able to be more precise in their treatments it could minimise the risks of patients being exposed to treatments that do not suit them – that is, to harmful substances – and treatments would not have to be administered unnecessarily. Precision medicine is not about knowing everything down to the level of the individual, but that treatment can be more precise when it is possible to adapt it to specific patient groups.”

Diabetes is a large and growing disease where, according to Paul Franks, patients are at great risk of blood lipid disorders and therefore cardiovascular disease. For the time being it is not possible to directly discover risk groups that may develop diabetes based on genetic profiles since this complex disease does not have a simple genetic cause. Instead, as in Viktor Hamrefors’ study, we must try to find the best treatment for different patient groups with complications such as cardiovascular disease.  

In precision medicine, there is a lot of work taking place with biomarkers and Paul Franks says these may also become important for the treatment of diabetes in the future.

“If we can discover better biomarkers to identify people at risk of developing diabetes early on, we will have better opportunities to prevent some secondary diseases. However, further research must be done before we can know if this is possible”, says Paul Franks.

More on precision medicine: Detailed characterisation of human biology and behaviour is now possible on a large scale thanks to several interacting factors. Firstly, through increasing innovation in biomarkers (for example, genetic profiling and the presence of proteins and metabolites), advanced imaging technology (such as computed tomography and ultrasound) and mobile technology, and secondly, through the fact that lifestyle data from electronic journals, health insurance databases and other platforms (so-called Big Data) is becoming increasingly accessible, as well as through fast development in computer calculation capacity and bioinformatics methods.  When it is possible to identify hidden structures within this complex data and link these to different results, it can provide unique insight into risk factors and disease progression of, for example, diabetes, which in turn can contribute to the optimisation of the prevention and management of the disease. This growing area is known as ‘precision medicine’. Source: Paul Franks
 

What is a biomarker?

A biomarker is a biological molecule that, when it is detected or exceeds a certain measured value, is used to draw a conclusion on, for example, the development of a disease.  
Caption: Doctors want to find patients at high risk of cardiovascular disease, stroke and diabetes more easily to be able to administer more individualised treatment.